Clinical Challenges

The patient is a 72-year-old woman who complains of multiple skin lesions on her lower legs. She says she first noticed them several months ago, appearing in a net-like pattern, then becoming painful ulcerations, and finally leaving atrophic scars. She is concerned because she had already had several bouts of deep vein thrombosis. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the …

The patient is a 54-year-old female woman who presents to urgent care with a 3-day history of nonproductive cough with associated rhinorrhea. She does endorse some chest pain after coughing episodes, which resolve with NSAIDs. She otherwise denies nausea, vomiting, diaphoresis, or exertional symptoms. Personal medical history is remarkable for hypertension. View the ECG and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

The patient is a 42-year-old man who presents with a symmetrical rash of palpable purpura on his legs. He also complains of a fever and arthralgia, but denies any headache or neck pain. He also discloses current infection with the hepatitis C virus. View the image taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.    

The patient is a 58-year-old female who reports having an episode of syncope earlier in the day. She denies chest pain, difficulty breathing, or recent illness. She has a history of hypertension, diabetes, coronary artery disease. View the ECG and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

The patient is a 6-year-old boy who cried out in pain after jumping off the fourth step of the stairs in his house yesterday, landing hard on his feet. His mother reports that he has been limping ever since. She applied ice at home, hoping the pain would resolve overnight. It did not. On exam, you note the pain is located at the base of the first/second metatarsal. View the images taken and consider what …

The patient is a 70-year-old male who presents to urgent care with numbness, pain, and difficulty opening his hands. His son, who drove his father to the appointment, notes that the skin also looks “bunched up in places.” The physician also observes what look like raised scars. The thumb and index finger seem unaffected. Upon questioning, the patient says he started noticing smooth nodules “a couple years ago.” He attributed that to his many years …

The patient is a 42-year-old woman who presents to urgent care after a child weighing approximately 70 pounds fell on her hand at a family gathering. Pain is severe around the base of the fifth metacarpal. On exam, you note soft tissue swelling in the ulnar aspect of the hand. View the images taken and consider what your diagnosis and next steps would be.

The patient is an 18-year-old male who presents to urgent care complaining of 1-day history of intermittent shortness of breath, as well as a sore throat. He reports that he woke up with “chest tightness” and “discomfort.” He is unable to take a deep breath. View the image taken and consider what the diagnosis and next steps would be. Resolution of the case is described on the next page.

The patient is an 8-year-old girl who is brought to your urgent care center by her father, who reports his daughter has had a sore throat and a fever for “a few days.” Most recently, a petechial rash has appeared, spreading from her head and neck down to her torso. She also started complaining of nausea. The father also observes that her tongue appears redder than usual. View the image and consider what your diagnosis …